Insertion aid with interference fit

ABSTRACT

The present disclosure relates to an insertion device including a shaft with a head supported on a distal end thereof. The shaft includes a proximal end with an engagement member that is configured to frictionally engage a distal end of a surgical fastening apparatus such that an interference fit is created therebetween to facilitate selective detachment of the insertion device from the surgical fastening apparatus. The head has an atraumatic configuration, and is dimensioned to be received in a body orifice.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of U.S. patent applicationSer. No. 12/233,824, filed on Sep. 19, 2008, which claims the benefitof, and priority to U.S. Provisional Application Ser. No. 60/995,025,filed on Sep. 24, 2007, and U.S. Provisional Application Ser. No.61/074,756, filed on Jun. 23, 2008, the entire contents of each of whichare incorporated by reference herein.

BACKGROUND 1. Technical Field

The present disclosure relates generally to surgical instruments and,more particularly, to an insertion device for use with a surgicalfastening apparatus.

2. Description of Related Art

During certain surgical procedures, it is often necessary to insert oneor more surgical instruments into a body cavity, e.g. through a naturalopening, or orifice, or through a percutaneous incision. In surgicalprocedures involving hollow organ tissue sections, such as colonsurgery, it is often necessary to remove a diseased or damaged holloworgan tissue section and insert a surgical apparatus trans-anally inorder to reconnect the healthy tissue sections.

In one known method relating to the resection of a target portion of thecolon, a fastening apparatus, such as a surgical stapler or multi-partfastening device, is inserted trans-anally. See, e.g., U.S. Pat. No.5,119,983, the entire contents of which are incorporated by referenceherein. During the procedure, the fastening component of the fasteningapparatus is positioned within the colon on one side of the targetportion that is to be removed. The fastening apparatus is then insertedinto the patient's body either through a natural body orifice or througha surgically created opening. The fastening apparatus is positionedwithin the colon on the other side of the target portion so that thehealthy sections surrounding the target portion can be attachedtogether. The fastening component is then connected to the fasteningapparatus, and the healthy sections are brought into abutment andfastened together. The fastening apparatus is then removed from thepatient.

Various apparatus are suggested in the art that may be used tofacilitate the insertion of a fastening apparatus into a body orificeand through a body lumen. For example, it has been suggested that astapling anvil can be attached to the fastening apparatus in an effortto provide a blunt surface that may be advanced through the body orificeor opening in the patient's tissue. Alternatively, U.S. Pat. No.5,404,870 discloses a device having a sheath that is open at both ends,through which a fastening apparatus may be inserted into a body orifice.U.S. Pat. No. 5,836,503 discloses an insertion device for use with asurgical fastening apparatus that includes a distal end configured tofacilitate the trans-anal insertion of the apparatus and subsequentmovement of the apparatus through a body lumen.

Despite the existence of each of the aforedescribed apparatus, it wouldbe advantageous to provide a device that safely and efficientlyfacilitates the insertion of a surgical fastening apparatus into and/orthrough a body orifice or opening in a patient's tissue while beingreadily removable thereafter.

SUMMARY

In one aspect of the present disclosure, an insertion device isdisclosed that includes a shaft having a proximal end with an engagementmember that is configured to frictionally engage a distal end of asurgical fastening apparatus. The frictional engagement creates aninterference fit between the insertion device and the surgical fasteningapparatus, which facilitates selective detachment of the insertiondevice to enable subsequent attachment of an anvil assembly to thesurgical fastening apparatus. The insertion device also includes a headsupported on a distal end of the shaft. The head has an atraumaticconfiguration and is dimensioned to be received in a body orifice. Thehead preferably defines a radius that is at least substantially equal toa radius of a distal end of the surgical fastening apparatus.

In one embodiment of the insertion device, the head may include at leastone attachment surface. The at least one attachment surface may beconfigured as a throughbore formed in the head, or alternatively, mayinclude a cross-member positioned within a recess defined in an externalsurface of the head. The at least one attachment surface can beconfigured to engage at least one removal member including a first endand a second end, wherein at least the first end of the at least oneremoval member is in engagement with the at least one attachmentsurface. Suitable, illustrative examples of the at least one removalmember include a suture, a wire, and a cable.

It is envisioned that the head and the shaft of the insertion device maybe integrally formed. Alternatively, however, the shaft and the head mayinclude corresponding structure configured and dimensioned to facilitateselective attachment of the shaft and the head. In such embodiments, theshaft may include at least one protrusion, e.g., a rib, extendingradially outward from the distal end of the shaft, and the head mayinclude internal receipt structure, with the at least one protrusiondefining a first transverse dimension greater than a second transversedimension defined by the internal receipt structure such that the shaftfrictionally engages the head to establish an interference fittherebetween upon assembly.

To establish frictional engagement between the insertion device and thesurgical fastening apparatus, and thus, the aforementioned interferencefit therebetween, in one embodiment of the insertion device, the shaftincludes an engagement member configured and dimensioned to engage aninternal wall at the distal end of the surgical fastening apparatus. Theengagement member may include at least one protrusion, e.g., a rib, thatextends radially outward from the shaft to engage the internal wall,defining a first transverse dimension that is greater than a secondtransverse dimension defined by the internal wall.

In another aspect of the present disclosure, a method of performing asurgical procedure is disclosed. The method includes the steps ofproviding a surgical instrument including a fastening componentreleasably attachable to a distal end thereof, positioning the fasteningcomponent within a patient, providing an insertion device, attaching theinsertion device to the distal end of the surgical instrument, advancingthe surgical instrument and the insertion device distally through a bodyorifice, detaching the insertion device from the surgical instrument,attaching the fastening component to the distal end of the surgicalinstrument, connecting adjacent tissue portions, removing the insertiondevice, and withdrawing the surgical instrument.

The insertion device of the above method includes a shaft having aproximal end with an engagement member that is configured tofrictionally engage a distal end of the surgical instrument such that aninterference fit is created therebetween to facilitate selectivedetachment of the insertion device from the surgical instrument. Theinsertion device further includes a head supported on a distal end ofthe shaft. The head has an atraumatic configuration and is dimensionedto be received in a body orifice.

It is also envisioned that insertion device may include a head having atleast one attachment surface. In this embodiment, the disclosed methodmay further include the step of attaching a removal member to the atleast one attachment surface formed on the head that is configured anddimensioned for grasping to facilitate removal of the insertion device.In this embodiment, the step of removing the insertion device preferablyincludes grasping the removal member.

In one embodiment, to detach the insertion device from the surgicalinstrument, the surgical instrument may be manipulated such that theinsertion device is advanced distally relative to a proximal end of thesurgical instrument, thereby forcing the insertion device out offrictional engagement with the distal end of the surgical instrument. Inone embodiment, the surgical instrument may include a handle assemblypositioned at a proximal end and a retaining member at a distal end thatis configured and dimensioned for removable positioning within the shaftof the insertion device. In this embodiment, the step of detaching theinsertion device from the surgical instrument includes manipulating thehandle assembly to thereby advance the retaining member distally,whereby distal advancement of the retaining member effectuates distaladvancement of the insertion device.

These and other features of the insertion device, surgical fasteningapparatus, and associated methods of performing a surgical proceduredescribed herein will become more readily apparent to those skilled inthe art from the following detailed description of various embodimentsof the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in, and constitute apart of this specification, illustrate embodiments of the disclosureand, together with a general description of the disclosure given aboveand the detailed description of the embodiment(s) given below, serve toexplain the principles of the disclosure, wherein:

FIG. 1 is a side schematic view of an insertion device in accordancewith a first embodiment of the present disclosure including anattachment surface in engagement with a removal member;

FIG. 2 is a side perspective view of a surgical fastening apparatus foruse with the insertion device of FIG. 1;

FIG. 3 is a side schematic view of an alternate embodiment of theinsertion device of the present disclosure;

FIG. 4 is a side schematic view of another alternate embodiment of theinsertion device wherein the removal member has a first end attached tothe attachment surface;

FIG. 5 is a side schematic view of an alternate embodiment having aremoval member having a substantially annular configuration inengagement with the insertion device of FIG. 1;

FIG. 6 is another embodiment of the insertion device of FIG. 1incorporating a plurality of bores;

FIG. 7 is a side view of the insertion device of FIG. 6;

FIG. 8 is a side view of an alternate embodiment of the insertion deviceof FIG. 1 shown in a disassembled condition with the head separated fromthe shaft; and

FIG. 9 is a cross-sectional view of the insertion device of FIG. 8 shownin an assembled condition and after attachment to the fasteningapparatus seen in FIG. 2.

DETAILED DESCRIPTION OF VARIOUS EMBODIMENTS

Various embodiments of the presently disclosed insertion device will nowbe described in detail with reference to the foregoing figures whereinlike reference numerals identify similar or identical elements. In thefigures, and in the description which follows, the term “proximal”, asis traditional, will refer to the end of the device that is closer tothe clinician, while the term “distal” will refer to the end of thedevice that is further from the clinician. In addition, the term“fastening apparatus” should be understood to include any deviceconfigured to attach one section of tissue to another, including but notbeing limited to a circular surgical stapler, such as the anastomosissurgical stapling instrument disclosed in U.S. Pat. No. 5,005,749, amultipart surgical fastening device, such as the fragmentableanastomosis ring applier disclosed in U.S. Pat. No. 5,376,098, or acircular anastomosis apparatus, such as the one disclosed in U.S. Pat.No. 5,119,983, the entire contents of which are each incorporated byreference herein. Finally, the terms “body orifice” should be understoodto include any opening formed in tissue, either pre-existing or createdby a practitioner.

FIG. 1 illustrates one embodiment of the presently disclosed insertiondevice 10 that is the subject of the present disclosure. Insertiondevice 10 includes a head 12 with a shaft 14 extending proximallytherefrom that is configured to releasably engage a fastening apparatus100 (FIG. 2) so as to facilitate the insertion of the fasteningapparatus 100 into a patient's orifice or body cavity.

Turning now to FIG. 2, fastening apparatus 100 will briefly bediscussed. Fastening apparatus 100 includes a proximal handle assembly102, an elongated central body portion 104 and a distal head portion106. The length, shape and/or the diameter of the central body portion104 and the head portion 106 may be varied to suit a particular surgicalprocedure. Head portion 106 includes a retaining member 108 that extendsdistally beyond a shell assembly 110. Retaining member 108 includes anannular protrusion 112 that is configured to releasably engage acorresponding structure on a fastening component (not shown), e.g. ananvil assembly, as well as on the insertion device 10 (FIG. 1) that isthe subject of the present disclosure, as discussed in further detailbelow. Further details regarding fastening apparatus 100 may be obtainedthrough reference to U.S. Pat. No. 7,168,604, the entire contents ofwhich are incorporated by reference herein.

Although the insertion device 10, and the various embodiments thereof,are described and depicted in connection with the fastening apparatus100 of FIG. 2, it should be understood that the insertion device 10 maybe used with any number of surgical devices where it is desirable tofacilitate the insertion thereof into a patient's orifice or bodycavity.

Referring again to FIG. 1, head 12 of insertion device 10 includes asmooth, atraumatic leading or outer surface 16 defining a radius that isat least substantially equal to the maximum radius of the distal end ofthe fastening apparatus 100 (FIG. 2) to which the insertion device 10 isto be attached. The size and configuration of head 12 facilitatesinsertion of fastening apparatus 100 into a body orifice andsubstantially prevents tissue from entering the shell assembly 110 ofthe fastening apparatus 100 during insertion. Head 12 has a proximal end18 that is connected to the shaft 14, and a substantially rounded distalend 20. To facilitate the releasable attachment of shaft 14 to theretaining member 108 (FIG. 2) of the fastening apparatus 100 to theinsertion device 10, the shaft 14 of the insertion device 10 includes aplurality of flexible fingers 22 and an internal shoulder 24 that isconfigured to releasably engage a corresponding annular protrusion 112(FIG. 2) formed on the retaining member 108, as discussed in furtherdetail below. The head 12 and the shaft 14 may be formed of any suitablebiocompatible material, including but not being limited to stainlesssteel or polymeric materials, and may be formed by various methods, e.g.injection molding.

Head 12 includes an attachment surface 26 configured to engage a removalmember 28. In the figures and description hereinbelow, each embodimentof the present disclosure will be discussed, and depicted in thecorresponding figures, as including a single attachment surface 26 and asingle removal member 28. However, the incorporation of one or moreadditional attachment surfaces 26 and removal members 28 is also withinthe scope of the present disclosure.

In one embodiment, as seen in FIG. 1, the attachment surface 26 isconfigured as a throughbore 30 formed in the head 12 of device 10. Inthis embodiment, the attachment surface 26 is configured to receive theremoval member 28 such that the removal member 28 passes through thehead 12 of device 10. The removal member can be in the form of a suture,wire or other flexible member insertable through the bore to enableremoval.

As seen in FIG. 3, in an alternate embodiment, an insertion device 110is disclosed that includes an attachment surface 126 configured as apartial recess or depression formed in head 112 such that a cross-member130 is defined. In this embodiment, removal member 28 is passed beneaththe cross-member 130 and is thereafter attached to the cross-member 130in any suitable manner, e.g. the removal member 28 is tied around thecross-member 130. It is noted that cross-member 130 preferably defines asmooth continuous surface along the exterior of head 112 to preventsnagging or tearing of tissue. The removal member in this embodiment aswell as the other embodiments described herein can be in the form of asuture, wire or other flexible member.

Referring now to FIGS. 1 and 2, following the detachment of device 10from fastening apparatus 100, the clinician may remove device 10 fromthe patient by grabbing or grasping removal member 28, or any otherportion of device 10 if more easily accessible. The present disclosurecontemplates the grasping of removal member 28, or the device 10,itself, through any suitable means, including but not being limited tousing a grasping apparatus (not shown) or the clinician's hand.

The removal member 28 may be associated with the attachment surface 26in any manner that facilitates the grasping thereof. As seen in FIG. 4,in one embodiment, a removal member 128 is disclosed that includes afirst end 132 that is connected to attachment surface 26 while a secondend 134 thereof remains free. Alternately, each of the respective firstand second ends 132, 134 of removal member 128 may be connected to theattachment surface 26, either releasably or fixedly, as discussed above.As seen in FIG. 5, in an alternate embodiment, a removal member 228 isdisclosed that exhibits a substantially annular configuration, e.g. asubstantially elliptical or circular configuration, that is devoid ofthe respective first and second ends 132,134 of the removal member 128(FIG. 4).

FIGS. 6 and 7 depict another embodiment of the insertion device that isthe subject of the present disclosure. Insertion device 210 performssubstantially in accordance with the insertion device 10 (FIG. 1)discussed above and generally includes a head 212 with a smooth,atraumatic leading outer surface 216, and a shaft 214 that extendsproximally therefrom. In this embodiment, head 212 has a substantiallyflat proximal surface 236 that is oriented so as to be substantiallyperpendicular to a longitudinal axis of the shaft 214. Proximal surface236 includes a plurality of recesses or bores 238 that serve to reducethe weight of insertion device 210 as well as reduce any suction effectsthat may be created between tissue and a surgical fastening device (notshown). In addition, head 212 includes at least one attachment surface26 (or alternatively 126 of FIG. 3) that is configured to engage atleast one removal member 28, as discussed above with respect to each ofthe embodiments of FIGS. 1 and 3-5. Similar to that of insertion device10 discussed above, shaft 214 of insertion device 210 includes flexiblefingers 22 and an internal shoulder (not shown) such that the insertiondevice 210 is configured for releasable engagement with the distal endof a fastening apparatus 100 (FIG. 2).

Referring again to FIG. 1, the shaft 14 of the insertion device 10 willbe discussed. Shaft 14 generally includes a shaft barrel 32 that definesa lumen 34 extending at least partially therethrough and flexiblefingers 22. The lumen 34 includes the internal shoulder 24 configured toreleasably engage the annular protrusion 112 (FIG. 2) formed on theretaining member 108 of the fastening apparatus 100.

Upon insertion of the retaining member 108 (FIG. 2) into the lumen 34,the flexible fingers 22 are splayed radially outward such that theretaining member may be received. As the retaining member 108 isadvanced distally through the lumen 34, the annular protrusion 112engages the internal shoulder 24, thereby releasably securing theinsertion device 10 to the fastening apparatus. Further detailsregarding the releasable engagement of the insertion device 10 with theretaining member 108 of the surgical fastening apparatus 100 may beobtained through reference to U.S. Pat. No. 7,168,604.

In alternate embodiments of insertion device 10, the annular protrusion112 (FIG. 2) and the corresponding receiving structure 22 of the shaft14 of the insertion device 10 may be any structure suitable for theintended purpose of facilitating the releasable engagement anddisengagement of the insertion device 10 and the surgical fasteningapparatus 100.

In one embodiment of the insertion device 10, the shaft barrel 32 isreleasably connected to the head 12. In this embodiment, the shaftbarrel 32 may be connected to the head 12 in any suitable manner,including but not being limited to a threaded connection or snap-fitarrangement therebetween, such that the head 12 is interchangeable witha variety of shafts, thereby facilitating the use of device 10 with avariety of fastening apparatus 100 (FIG. 2). In an alternate embodimentof the device 10, the shaft barrel 32 and the head 12 may be integrallyformed.

Referring now to FIGS. 2 and 8-9, an alternate embodiment of theinsertion device, referred to generally by reference number 310, will bediscussed in connection with the fastening apparatus 100. The insertiondevice 310 includes a head 312 and a shaft 314, and is similar to theinsertion device 10 discussed above with respect to FIGS. 1-7.Accordingly, the insertion device 310 will only be discussed withrespect to its differences from the insertion device 10.

The head 312 defines a generally conical configuration having asubstantially blunt distal end 340 to facilitate atraumatic insertion.The distal end 340 includes the aforedescribed attachment surface 326for the reception of a removal member 328. While the embodiment of thehead 312 seen in FIGS. 8-9 depicts the attachment structure 326 asincluding a throughbore 330 that extends through the head 312, alternateconfigurations for the attachment structure 326 are also within thescope of the present disclosure. The head 312 further includes internalreceipt structure 342 to facilitate attachment of the head 312 to theshaft 314, and thus, assembly of the insertion device 310.

The shaft 314 extends proximally from the head 312 and includesattachment structure 344 formed at the distal end 346 thereof that isconfigured and dimensioned to frictionally engage, and mechanicallycooperate with, the receipt structure 342 formed in the head 312. In theparticular embodiment seen in FIGS. 8-9, the attachment structure 344includes a plurality of first ribs 348 extending radially outward fromthe distal end 346 of the shaft 314 such that the distal end 346 definesa transverse dimension “D.sub.S”. The transverse dimension “D.sub.S” isgreater than the internal transverse dimension “D.sub.H” defined by thereceipt structure 342 formed in the head 312 such that an interferencefit is created upon insertion of the distal end 346 of the shaft 314into the head 312, as seen in FIG. 9. It is contemplated that the head312 and shaft 314 can be permanently affixed or removed attached by theaforedescribed structure or other structure.

The shaft 314 further includes an engagement member 350 locatedproximally of the plurality of splines 352 formed about the shaft 314,which mate with a plurality of corresponding grooves 114 formed in theshell assembly 116 of the fastening apparatus 100. In the particularembodiment seen in FIGS. 8-9, the engagement member 350 includes asecond rib 354 extending outwardly from the shaft 314 to define atransverse dimension “D.sub.E”. The transverse dimension “D.sub.E” isgreater than an internal transverse dimension “D.sub.B” defined by theinternal wall 118 of the shell boss 120 component of the shell assembly116. The engagement member 350 frictionally engages, and mechanicallycooperates with, the internal wall 118 to create an interference fitwhich ensures that the insertion device 310 remains attached to thefastening apparatus 100 during insertion, e.g., by preventinginadvertent displacement of the insertion apparatus 310. Whendisconnection of the insertion device 310 from the fastening apparatus100 is desired, the clinician manipulates the approximation knob 122(FIG. 2) of the handle assembly 102 to advance the retaining member 108(FIG. 2), and thus, the insertion device 310, distally. As the insertiondevice 310 is advanced distally, the engagement member 350 is forced outof contact with the internal wall 118 of the shell boss 120, therebyfacilitating removal of the insertion device 310 from the fasteningapparatus 100. Further details regarding the components and structure ofthe fastening apparatus 100 can be obtained through reference to U.S.Pat. No. 7,303,106, the entire contents of which are incorporated byreference herein.

In one embodiment, the apparatus 100 is packaged with the insertiondevice connected to the retaining member 108 and the instrumentapproximately ¾ clamped (about one full turn from full approximation).In this packaged configuration, the apparatus is ready for insertion,with the insertion device secured on the instrument, but the safetycannot be disengaged so the surgeon cannot inadvertently fire theinstrument (unless the surgeon further approximates the instrument). Forremoval of the insertion device, the instrument can be unclamped(unapproximated) in the manner described above.

While the attachment structure 344 and the engagement member 350included on the shaft 314 are respectively illustrated as first andsecond ribs 348, 354, in alternate embodiments, the attachment structure344 and the engagement member 350 may be configured as any protrusionsuitable for the intended purpose of creating an interference fit withthe head 312 and the fastening apparatus 100, respectively, includingbut not being limited to spherical bumps or the like. In one embodiment,four ribs or four bumps are provided, although a different number isalso contemplated to achieve the attachment function.

The insertion devices disclosed herein can be reusable (re-sterilized)and made of material such as aluminum, or can be disposable (single use)made of material such as plastic. In one embodiment of the metalversion, the shaft and head are welded together. In one embodiment ofthe plastic version, the shaft and head are ultrasonically weldedtogether. In a preferred embodiment of the reusable insertion device,four ribs for providing an interference fit with the instrument retainerare provided. In a preferred embodiment of the reusable version, foursubstantially spherical bumps are provided.

It will be understood that various modifications can be made to theembodiments disclosed herein. For example, as noted hereinabove, thedisclosed embodiments are suitable for use with various surgicalfastening apparatus and can be varied to accommodate the same.Additionally, the various embodiments need not prevent activation of thetissue fastening apparatus but can be dimensioned and configured toprovide ease of insertion only. Therefore, the above description shouldnot be construed as limiting, but merely as exemplifications ofpreferred embodiment. Those skilled in the art will envision othermodifications within the scope and spirit of the claims appended hereto.

1-20. (canceled)
 21. A method of introducing a surgical instrument intoa body cavity, the method comprising: coupling an insertion device to aretaining member of the surgical instrument by frictional engagement;inserting the surgical instrument and the insertion device into the bodycavity; and advancing the retaining member of the surgical instrumentwithin a shell assembly of the surgical instrument to detach theinsertion device from the surgical instrument.
 22. The method of claim21, further comprising attaching a fastening component to the retainingmember after the insertion device is detached from the surgicalinstrument.
 23. The method of claim 21, wherein inserting the surgicalinstrument and the insertion device into the body cavity includesinserting the surgical instrument and the insertion device into the bodycavity through a natural body orifice.
 24. The method of claim 21,wherein inserting the surgical instrument and the insertion device intothe body cavity includes inserting the surgical instrument and theinsertion device into the body cavity through a percutaneous incision.25. The method of claim 21, further comprising attaching a removalmember to the insertion device.
 26. The method of claim 25, furthercomprising manipulating the removal member to remove the insertiondevice from the body cavity after the insertion device is detached fromthe surgical instrument.
 27. The method of claim 21, wherein coupling aninsertion device to a retaining member of the surgical instrument byfrictional engagement includes moving an engagement member of theinsertion device proximally through a shell boss of the shell assembly.28. The method of claim 27, wherein coupling an insertion device to aretaining member of the surgical instrument by frictional engagementfurther includes receiving a protrusion of the engagement member havinga first transverse dimension between a pair of internal walls of theshell boss, wherein the internal walls of the shell boss define a secondtransverse dimension that is less than the first transverse dimension.29. A method of introducing a surgical instrument into a body cavity,the method comprising: attaching a proximal end portion of a shaft of aninsertion device to a distal end portion of the surgical instrument, theproximal end portion of the shaft including an engagement memberconfigured to frictionally engage the distal end portion of the surgicalinstrument; inserting an atraumatic head of the insertion device intothe body cavity to introduce the surgical instrument into the bodycavity; advancing a retaining member of the surgical instrument within ashell assembly of the surgical instrument to detach the insertion devicefrom the surgical instrument.
 30. The method of claim 29, furthercomprising: attaching a removal member to an attachment surface formedon the head of the insertion device.
 31. The method of claim 30, furthercomprising: grasping the removal member to remove the insertion devicefrom the body cavity.
 32. The method of claim 29, wherein inserting anatraumatic head of the insertion device into the body cavity includesinserting the surgical instrument and the insertion device into the bodycavity through a natural body orifice.
 33. The method of claim 29,wherein inserting an atraumatic head of the insertion device into thebody cavity includes inserting the surgical instrument and the insertiondevice into the body cavity through a percutaneous incision.